The worrying depression rate of abused partners NUR 201 KAA Shelly Mezheritsky Seneca College Lisa Keenan-Lindsay October 15th

The worrying depression rate of abused partners
NUR 201 KAA
Shelly Mezheritsky
Seneca College
Lisa Keenan-Lindsay
October 15th, 2018
One of the most common forms of domestic violence is between intimate partners, commonly referred to as Intimate Partner Violence (IPV). IPV has an immensely strong impact on how one perceives their sense of health, as well as their personal definition of it. The article titled “Intimate Partner Violence Associated with Postpartum Depression, Regardless of Socioeconomic Status” discusses how IPV has a greater affect on women experiencing post partum depression compared to poverty (Kothari et al, 2016). This study was conducted in Kalamazoo County where 301 postpartum women, 2 months after delivery, were interviewed through a cross – sectional survey study screening them for IPV and depression. Upon analysis of the article, it is apparent that nurses should be looking out for signs of abuse in the postpartum environment, as well as learning about resources and possible interventions that could help support mothers from spiraling into PPD.
Key Points
In the article, there were three distinct points that significantly stood out. The first significant point in the article was, no matter how many studies and various test were conducted, IPV always outweighed poverty as the greatest factor affecting depression, even though there were certain results where IPV and poverty went hand in hand. One of the tests conducted determines the availability of coping resources to the number of stressors one has in their life, this was called the ‘Stress Process Model’. The study states that depression rates are higher in postpartum women, associating IPV with socioeconomic status. No matter how many major impactful factors are combined to determines one’s poverty level, they are not significant enough to outweigh the great effect IPV has on depression. The ‘Stress Process Model’ stated that these same women, who suffer from poverty, have five to six times greater incidence of IPV than women of higher socioeconomic status. A final study conducted called the ‘Final Regression Model’ wrapped all the side factors that could potentially influence poverty. The study concluded that although there were various stressors accounted for, there was a clear correlation that indicated IPV was a much more significant contributing factor to PPD then poverty. A significant point that correlates and enhances the fact that IPV is independent of poverty are other covariates that were related to EPDS, a scale that measures the severity of postpartum depression. People who might have instability in their life, often turn to smoking or substance abuse which worsens their situations significantly. These factors along with unplanned pregnancy could change one’s mental state. Although the multiple linear regression study revealed that only three variables were associated with postpartum depression and the data remained the same even after IPV and poverty were added into the model. Once again demonstrating that socioeconomic status does not have a significant enough role to impact depression. The last main point revolves around perinatal women not seeking help if they experience symptoms of depression. A great portion of a postpartum women’s mental health can be better if one acts into improving their circumstances, especially since a woman’s perinatal period is a universal insurance coverage. The great majority of perinatal women do not want to get out of their comfort zones and seek help even though some of these comfort zones are detrimental to their health. Women in general would be much healthier and more stable if they had the motivation and a will to change their lifestyles, with addition to proper nursing teaching. Overall, through various studies and research conducted, socioeconomic status has no affect on the association of IPV with PPD.
Nursing Actions
The importance of teaching patients on the impact that IPV has on depression plays a crucial role in how moms and their children’s mental health will develop in the future that most of the general population fails to realize. Nurses should be on the lookout for signs of potential abuse throughout their 24 hours stay in the hospital, so that proper teaching and nursing interventions could be put together in order to maximize therapeutic effect for the patient and help prevent IPV, which can have an influence on how depression will be perceived in the future. Not only do nurses need to educate and watch out for signs of postpartum blues and depression but also keep in mind about previous screening files done on the patient. Whether these files show great or minimal history with IPV and depression. Asking the right questions will help guide the conversation to a more specific topic that relates to the patient. For instance, asking “Do you feel safe in your current relationship?” would be a good conversation starter regarding IPV (Perry, 2017).
Social support networks have incredible life changing advantages to those experiencing any sort of distress in their life, in this case, one’s mental health. Throughout the nurses teaching process on IPV and the effects it has on depression, the use of resources should be very prominent in all discussions on the bettering of the perinatal women’s health. Most women do not know, and do not realize that such resources are available, that is why instructing patients to seek help is crucial. Resources, specifically social support networks play a unique role on one’s way of thinking and coping. Teaching about the importance of IPV with association to depression can help women understand that any sort of partner violence is completely unacceptable, and if any sort of negative attributes arises from a spouse, she should turn to help immediately. While thoroughly researching about various resources that could help a mother who is experiencing IPV and depression I came across the huge benefit of antenatal classes. Antenatal classes mainly focus on a group discussion on labour and birth, but in the RNAO article, mothers mentioned that postpartum depression should be an open discussion in these classes. Stating that not only do they greatly inform about the signs and symptoms, but also give the opportunity to create trusting relationships and various socials support networks (Virani al., 2016). In my future nursing practice, I will most definitely implement the importance of attending social support networks especially antenatal classes as it gives a chance for mothers to open up in a welcoming environment. In addition to antenatal classes, talking therapies with health professionals is an option mothers would like to be available. It encourages them to talk about their feelings with people who spend their time listening, making health professionals very valued in mothers’ eyes (Virani et al., 2016). As an additional resource to social support networks I will guide mothers in speaking with a health professional one on one, since it could have a completely different impact on the mother. Additionally, with guiding mothers to these helpful resources I will call them back after a month to follow up on their progress as it is a good time period for the mother to build up confidence and make progress within that time frame, this information will help personalize care and guidance for the patient.
Watson
After reviewing Watsons 10 caritas processes, I decided to implement Watson’s 8th process, “creating a healing environment at all levels; subtle environment for energetic authentic caring presence”. By applying this process throughout my teachings of IPV, I’ll be able to greatly benefit not only the patient but also myself, as a nurse, to give my utmost attention on specific and more urgent issues surrounding the patient’s mental health. Creating an open welcoming environment is one of the first steps to helping a patient open up about their problems. This establishes a therapeutic relationship with the patient and can lead to a more effective care plan. Getting rid of extra disturbances in the room and establishing comfort, will generate focus and create a trusting environment that will ultimately lead to an open discussion. Once a patient realizes that the attention is completely on them they will be able to talk about personal issues like abuse at home and the effects it has on their mental and physical state. To help my patient, create a healing environment I can ask them questions like; “Is there anything else you would like me to do before we get started?” Or, “Are you comfortable sitting here?”. These questions will further aid in a healing environment and show the patient that I am here for them, I am willing to listen, and I am willing to help, focusing solely on them.

Conclusion
In conclusion, intimate partner violence associated with postpartum depression is an important issue that with the use of nursing interventions such as proper teaching about IPV, and providing patients with the proper resources, we as a healthcare society can come closer to solving this problem and moving forward towards better health care practices in the postpartum environment. Nurses who really invest their time with each patient and learn how to quickly pick up signs, as well as constantly learning about various resources to ultimately support patients with PPD will prosper greatly in their therapeutic care.

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References
Kothari, C. L., Liepman, M. R., Tareen, R. S., Florian, P., Charoth, R. M., Haas, S. S., . . . Curtis, A. (2016). Intimate Partner Violence Associated with Postpartum Depression, Regardless of Socioeconomic Status. Maternal and Child Health Journal,20(6), 1237-1246. doi:10.1007/s10995-016-1925-0
Virani, T., Gracon, S. L., McConnel, H., Santos, J., Schouten, J. M., Russell, B., . . . Powell, K. (2018). Interventions for postpartum depression. Retrieved from https://rnao.ca/sites/rnao-ca/files/Interventions_for_Postpartum_Depression.pdf
Virani, T., Schouten, J. M., McConnell, H., Gracon, S. L., Santos, J., Russell, B., . . . Powell, K. (2012). Woman Abuse: Screening, Identification, and Initial Response. Retrieved from https://rnao.ca/sites/rnao-ca/files/BPG_Woman_Abuse_Screening_Identification_and_Initial_Response.pdf
Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., Wilson, D., Keenan-Lindsay, L., & Sams, C. A. (2017). Maternal child nursing care in Canada. Toronto, ON: Elsevier Canada.

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